1780736264 NPI number — MERCY GENERAL HEALTH PARTNERS AMICARE HOMECARE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780736264 NPI number — MERCY GENERAL HEALTH PARTNERS AMICARE HOMECARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY GENERAL HEALTH PARTNERS AMICARE HOMECARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780736264
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9185
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMINGTON HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48333-9185
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-542-8213
Provider Business Mailing Address Fax Number:
734-542-8201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
888 TERRACE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUSKEGON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49440-1220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-726-5025
Provider Business Practice Location Address Fax Number:
231-728-4958
Provider Enumeration Date:
01/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
REDMOND
Authorized Official First Name:
VIRGINIA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF REVENUE CYCLE
Authorized Official Telephone Number:
734-542-8213

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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